Babylon Health has made headlines in recent months through its work within the NHS on developing digital technology and the use of its GP at Hand smartphone app. So who is Babylon Health and what is it doing within the NHS?

Who started the company?
Babylon Health was founded in 2013 by former investment banker Ali Parsa, who until December 2012, was CEO of Circle Health. Circle Health was the private company that was awarded a ten year contract to run Hinchingbrooke Hospital in 2012 and abandoned it three years later in 2015.

What technology has Babylon Health developed?
The company has developed a smartphone app which is designed to answer medical queries through the use of a question and answer format. The app can then put the user in-touch (virtually) with a GP. Babylon says the technology is a form of artificial intelligence (AI).

The app can be personalised by the use of a dashboard of the users health statistics acquired either by the phone (exercise regime etc.) or via supplemental devices. Babylon will supply users with blood testing kits for liver and kidney function, thyroid function, vitamin levels, bone density and cholesterol. The results of the tests are then incorporated into the user’s app settings.

In the UK, the company offers a private service via its app; the service has a subscription charge plus extra costs on top, such as £25 for a remote GP consultation.

Babylon’s primary target in the UK, however, is gaining access to NHS patients. The company has a contract with NHS England for its app under the name GP at Hand. The service was launched in London in 2015 and expanded in 2017. Over 40,000 patients are now registered with the GP at Hand app.

What does Babylon Health do in the NHS?
Babylon Health has a contract with NHS England to register patients to the GP at Hand app. The contract is through the GP surgery of Dr Jefferies and Partners, based in Lillie Road, Fulham in West London. All patients who sign up with GP at Hand are registered at this Fulham surgery.

If patients registered with GP at Hand need to see a GP or nurse in person they must make an appointment at the Lillie Road, Fulham surgery or at one of four other surgeries in central London.

All patients who sign up with GP at Hand must de-register from their own NHS surgery and re-register with the Fulham practice. Under the Government’s ‘GP Choice’ scheme, this surgery can sign up patients outside its traditional boundaries. As a result, Babylon has been able to target patients who live across London and those who work in zone 1 to 3.

Since the company began its NHS England contract, over 40,000 patients have registered at this single Fulham surgery. The company promises that patients will be able to ‘book an appointment within seconds’ and have ‘a video consultation with an NHS GP typically in under two hours of booking, anytime, anywhere’.

Initially, GP at Hand could not register certain groups of patients, but in November 2018, NHS England lifted all restrictions on the type of patient that can register with GP at Hand.

In February 2019, NHS England cleared the way for GP at Hand to expand to Birmingham. Patients who sign up in Birmingham will also be registered at the Fulham surgery in London, although the company will have a physical clinic in Birmingham.

What concerns surround Babylon Health?

Cherry-picking
Both the RCGP and BMA have criticised Babylon for ‘cherry picking’ younger, healthier patients, leaving other GP practices to deal with patients requiring more complex care. GP at Hand can be used by all patients, however this type of digital service is more likely to appeal to a younger, fitter, healthier demographic and is unlikely to be used by older patients with complex needs.

This cherry-picking of healthier patients is an issue due to the way GPs are paid. GPs are paid per patient and rely on risk pooling and cross subsidy in that the fee for their younger fitter patients, who consult less often, subsidises the more expensive care for the more complex and elderly patients.

A report in November 2018 by GP Online confirmed the predictions that the GP at Hand service will attract younger, fitter patients. It found that in April 2017, 16% of patients at GP at Hand’s Lillie Road surgery were aged between 20 and 29 years old, but by November 2018 this had risen to 49%. Of the 31,519 new patients who had signed up with GP at Hand over the previous 12 months, 87% were aged between 20 and 39 years old. Patients that are over 65 now made up just 1% of the population registered with the service – compared with around 10% in April 2017.

Destabilisation of local health economy
In March 2018, Pulse reported that the success of GP at Hand was leaving the local health commissioners, Hammersmith & Fulham CCG, with a deficit. The influx of patients from across London has increased the CCG’s costs significantly. Within a short space of time the CCG has around 40,000 more patients than it budgeted for.  In May 2018 the CCG reported that it would need an additional £18 million in extra funding to cope with the influx of patients.

In January 2019, Hammersmith and Fulham CCG reported a deficit of £2.5 million. The CCG stated that Babylon’s GP at Hand is the ‘key driver’ of cashflow issues. The CCG has noted that as Babylon continues to run advertising campaigns across London for new patients things are likely to get worse. The CCG has also noted that the costs associated with the Babylon GP at Hand practice could ‘jeopardise’ other health and care services in the area.

Deskilling of GPs
There are concerns about the effect on GP skill levels; GPs that move to work for Babylon will not face the great variety of cases seen in a normal practice. In particular, the GPs will lose skills in the area of care of the elderly and frail and in mental health.

Referral Problems
In mid-2018 it came to light that there were issues with referrals by GP at Hand for mental health services and community care outside of the Hammersmith & Fulham CCG area. GP at Hand was referring patients to services within their own CCGs, closer to where they actually lived. However, other London CCGs and providers said they were unable to accept these referrals.

After Hammersmith and Fulham CCG intervened and agreed to pay for the patients’ treatment, most neighbouring CCGs and services agreed to accept referrals.

However, this now leaves Hammersmith & Fulham CCG having to pay for a large amount of out-of-area treatment. This is a major driver of the deficit that Hammersmith & Fulham CCG has accumulated (see destabilisation of the health economy).

Performance concerns
Babylon Health is very positive about the capabilities of its GP at Hand app, claiming that it has outperformed doctors and nurses. Others are not so positive. An anonymous NHS doctor who tweets under the name @DrMurphy11 has tested the Babylon app repeatedly, highlighting problems, including when he posed as 48 year old, 40 a day male smoker who wakes “with a shoulder pain radiating down his arm” –  the Babylon app told him his symptoms could be managed at home with a cold compress and painkillers, when a heart attack should have been considered. Dr Murphy has a series of tweets known as the ‘bad bot threads’ that highlight the issues with the Babylon Health App.

In July 2017, an inspection of the GP at Hand service resulted in a critical report, which raised concerns about the potential for prescription misuse and lack of information sharing with a patient’s primary GP. However, the report also stated that most services “were safe, effective, caring, responsive and well-led.”

Babylon Health tried to suppress the publication of this report, taking the CQC to the High Court in December 2017. The high court ruled that the report could be published; Babylon then criticised the CQC and questioned whether the regulator has the ability to regulate digital health services. In late December 2017, Babylon dropped the legal case against the CQC and agreed to pay £11,000 in legal costs.

Misleading advertising
In October 2018 the Advertising Standards Authority (ASA) upheld complaints about Babylon Health’s adverts on the Underground in London. The complaints were that the ads were misleading because they did not make clear that in order to use the services advertised consumers must leave their current GP; and the GP at Hand service, including its in-person consultations, was only available to consumers who lived or worked in the catchment area of specific GP surgeries. The complainants also challenged whether the claim “See an NHS GP in minutes” in the ads was misleading. The ASA told Babylon Health that the ads must not appear again in their current form.

By January 2019, six other complaints made to the ASA regarding Babylon Health’s advertising had been resolved informally, according to the ASA website.

Does the Government support Babylon Health?
Well Babylon Health certainly has a supporter in the Health and Social Care Secretary, Matt Hancock, who is himself a subscriber to GP at Hand.

Matt Hancock has, what seems to many, an inappropriately close relationship with Babylon Health. In September 2018, Mr Hancock gave a speech at Babylon’s headquarters in which he told an audience of Babylon Health staff he wants to help the company expand “so loads of companies can come do what Babylon are doing” in the NHS.  And in November 2018 Mr Hancock praised the company in a paid-for article in the Evening Standard; the Labour Party says this broke ministerial code and has demanded an enquiry.

What is the financial background of Babylon Health?
The company has a complicated structure with several companies registered at UK Companies House. However, the operating company is a subsidiary of Jersey-based Babylon Holdings Ltd. The ultimate controlling party is ALP Partners Ltd, a company run by Nedgroup Trust on behalf of the Parsa Family Trust. This company is based offshore.

Who has invested in Babylon Health?
Babylon is funded by private equity. It has undertaken two rounds of funding: in January 2016 Babylon raised $25 million and in April 2017, the company raised $60 million.

Lead investors include the Swedish investment group AB Kinnevik; Demis Hassabis and Mustafa Suleyman, the founders of DeepMind, the British artificial intelligence company acquired by Google; Sawiris, an Egyptian billionaire business family, NNS holdings, and Vostok New Ventures.

In February 2019, the FT reported that Babylon Health was seeking to raise $400 million for ongoing expansion.

 

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